Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Circ J. 2010 Jul;74(7):1364-71. doi: 10.1253/circj.cj-09-0993. Epub 2010 May 22.
Previous studies demonstrated that beta-blocker use at the time of hospital discharge significantly increased postdischarge treatment rates, associated with an early (60- to 90-day) survival benefit in patients with heart failure (HF). However, it is unknown whether this therapeutic approach can also improve the long-term survival. We thus examined the long-term effects of beta-blocker use at discharge on outcomes in patients hospitalized for HF and left ventricular systolic dysfunction (LVSD) (ejection fraction <40%).
The Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD) enrolled HF patients hospitalized with worsening symptoms and they were followed during an average of 2.2 years. A total of 947 patients had LVSD, among whom 624 (66%) were eligible to receive a beta-blocker at discharge. After adjustment for covariate and propensity score, discharge use of beta-blocker, when compared to no beta-blocker use, was associated with a significant reduced risk of all-cause mortality (hazard ratio (HR) 0.564, 95% confidence interval (CI) 0.358-0.889, P=0.014) and cardiac mortality (HR 0.489, 95%CI 0.279-0.859, P=0.013) after hospital discharge.
Beta-blocker use at the time of discharge was associated with a long-term survival benefit in a diverse cohort of patients hospitalized with HF.
先前的研究表明，心力衰竭（HF）患者出院时使用β受体阻滞剂可显著提高出院后的治疗率，并带来早期（60-90 天）生存获益。然而，尚不清楚这种治疗方法是否也能改善长期生存。因此，我们研究了出院时使用β受体阻滞剂对因左心室收缩功能障碍（射血分数<40%）而住院的 HF 患者结局的长期影响。
日本心脏病学心力衰竭注册研究（JCARE-CARD）纳入了因症状恶化而住院的 HF 患者，平均随访 2.2 年。共有 947 例患者存在左心室收缩功能障碍，其中 624 例（66%）符合出院时使用β受体阻滞剂的条件。在校正协变量和倾向评分后，与未使用β受体阻滞剂相比，出院时使用β受体阻滞剂与全因死亡率（风险比（HR）0.564，95%置信区间（CI）0.358-0.889，P=0.014）和心脏死亡率（HR 0.489，95%CI 0.279-0.859，P=0.013）显著降低相关。
在 HF 住院患者的多样化队列中，出院时使用β受体阻滞剂与长期生存获益相关。
